Return To Main Article:
Guide To Ovarian Cancer
|What Does Cancer Staging Mean?
Once you have received an ovarian cancer diagnosis, doctors will carry out a process known as staging to determine how far the cancer has spread from the original tumor or source. The exact stage of the disease is important for deciding the best course of treatment. The accuracy of the staging is critical because if cancer is not staged properly parts of it may be missed and not treated. Ask your cancer care team to explain the staging process to you and after surgery find out what stage has been diagnosed. This will enable you to take a take a more active role in determining your treatment.
How Is Ovarian Cancer Staged?
A laparoscopy is a minimally invasive procedure which allows a surgeon to look inside the pelvis and abdomen with a lighted tube. It may be used as part of the staging process and also to rule out other conditions such as endometriosis, ovarian cysts and fibroids. Usually a laparotomy will be performed; this is a surgery to open the pelvis and abdomen so that the surgeon can look directly inside at the organs. The surgeon will probably remove the tumor and send biopsy samples to a lab for testing. Examination of the tissue under microscope will reveal if cells are malignant. Staging surgery can in fact be seen as the first part of ovarian cancer treatment. As most women with epithelial cancers (see types of ovarian cancer) usually have some spread of the disease, more therapy is nearly always required. Surgery and chemo (chemotherapy guide) may be recommended depending on the size, stage and location of the tumor.
Ovarian cancer is staged according to the International Federation of Gynecology and Obstetrics System (FIGO) and the American Joint Committee on Cancers (AJCC) TNM Classification. Both systems are broadly similar. The TNM definition bases staging on the size of the primary tumor (T), the amount of lymph nodes affected (N) and if there is metastasis (M). So the best TNM classification you could hope for would be T0 N0 M0, which means there is no sign of a tumor. The following is a more detailed definition of each TNM classification in relation to ovarian cancer.
Primary Tumor (T)
TX: No information available.
T1: Tumor/cancer is confined to one or both ovaries.
T1a: Cancer limited to one ovary, it does not penetrate the covering of the ovary (called capsule) and it is not found in a sample of fluid taken from the pelvis.
T1b: Same as T1a but found in both ovaries.
T1c: Cancer is found in one or both ovaries but has invaded the outside of the ovary or grown through the ovary capsule or is found in fluid in the pelvis.
T2: Cancer is found in one or both ovaries and has spread to the pelvic tissues.
T2a: Cancer has metastasized (spread) to the uterus and/or fallopian tubes but is not found in a pelvis fluid sample.
T2b: Cancer has spread to pelvic tissues located near the fallopian tube and uterus but is still not in pelvic fluid.
T2c: Like T2a or T2b but cancer is also found in pelvic fluid sample.
T3: Cancer is in one or both ovaries and has spread to the peritoneum (abdominal lining outside of the pelvis).
T3a: Metastases are so small they can only be seen under a microscope.
T3b: Metastases can be seen with the eye but are no larger than 2cms.
T3c: Metastases are larger than 2cm.
Regional lymph nodes (N)
NX: No information available.
N0: No lymph nodes are infected.
N1: Cancer cells are discovered in lymph nodes closest to the tumor.
Distant metastasis (M)
M0: Cancer has not spread.
M1: Cancer has spread to other organs such as the liver or lungs.
Will I survive? See our article on Ovarian cancer survival rates.
The Stages Explained
Cancer is still contained within one or both ovaries.
FIGO: Stage 1a
TNM: T1a, N0, M0
Growth is limited and confined to one ovary. The outer surface (capsule) is intact. Samples of cells from the pelvis or abdomen did not find cancer.
FIGO: Stage 1b
TNM: T1b, N0, M0
Cancer is located in both ovaries but has not spread to the capsules. No sign of cancer in pelvis fluid.
FIGO: Stage 1c
TNM: T1c, N0, M0
Tumor is at either stage 1a or 1b but also located on the surface of one or both ovaries. The capsule has ruptured and lab exams have found cancer in the pelvis fluids.
FIGO: Stage 2
Cancer in one or both ovaries and has involved other organs such as the fallopian tube, uterus, bladder, colon or rectum. It has not spread to lymph nodes, the peritoneum or distant areas of the body.
FIGO: Stage 2a
TNM: T2a, N0, M0
Cancer has invaded the fallopian tubes and/or uterus. No sign of cancer in washing (sample) from the abdomen.
FIGO: Stage 2b
TNM: T2b, N0, M0
Cancer has spread to other organs such as the colon, bladder or rectum.
FIGO: Stage 2c
TNM: T2c, N0, M0
Tumor is at either stage 2a or 2b. It is located on the surface of one or both ovaries or the capsule has ruptured. Cancer cells were found in fluid from washings of the abdomen.
FIGO: Stage 3
Cancer found in one or both ovaries, and one or both of the following are present: Cancer has spread outside of the pelvis to the lining of the abdomen; and/or cancer has spread to lymph nodes.
FIGO: Stage 3a
TNM: T3a, N0, M0
During staging surgery such as laparotomy, the surgeon can see cancer on the ovary or ovaries but none is visible to the eye in the abdomen or lymph nodes. After surgery, under microscope tiny areas of cancer are discovered in the lining of the upper abdomen.
FIGO: Stage 3b
TNM: T3b, N0, M0
Cancer found in one or both ovaries but also in areas large enough to see (still smaller than 2cm) in the abdomen. It has not spread to the lymph nodes.
FIGO: Stage 3c
TNM: any T, N1, M0
Cancer found in the abdomen is larger than 2cm (T3c, N1, M0) and/or is present in the lymph nodes (any T, N1, M0).
FIGO: Stage 4
TNM: Any T, any N, M1
This is the most advanced stage of the disease and cancer has spread to distant organs such as the lungs or liver. Finding (image) fluid in the lungs (pleural fluid) by X-ray is further evidence of stage 4 ovarian cancer. Women treated with Stage 4 are more likely to experience an ovarian cancer recurrence than any other stage of the disease.
Compare Staging Processes For Other Female Cancers
Breast Cancer Staging
Cervical Cancer Stages
Fallopian Tube Cancer Staging
Endometrial Cancer Staging
Vaginal Cancer Stages
Vulva Cancer Staging